Is lab automation part of the solution to save lives?
We expect that increasing automation of laboratories in the health care sector has the potential to not only reduce costs and improve efficiencies, but also result in improved patient health and longevity. This article focuses on the subject of lab automation, which we believe is just one of the ways technology is starting to revolutionize the health care sector and improve the “safety” of the world population.
An overlooked cause of death
Heart disease, cancer, and respiratory disease are widely known as the leading causes of death in the world1. Not commonly recognized as a cause of death however, is medical error. Medical error is typical not cited as the cause of death on death certificates nor does it feature in the statistical rankings.
However, according to a report from John Hopkins School of Medicine published in the British Medical Journal (BMJ), medical error was in fact found to be a significant cause of death, and would rank third in the statistical rankings in the US. The report estimates that more than 251,000 deaths in 2015 in the US were due to medical error, while deaths resulting from respiratory disease numbered just 149,000. Heart disease and cancer remained the leading causes, responsible for over half a million death each2.
The cost of inadequate diagnostics
Failure in lab analysis, incorrect diagnosis and medication and complications in surgery, are the most frequent sources of medical error3. In a previous Thematic Insight we wrote on the subject of rising antibiotic resistance and its total cost to society approximating USD 20 billion4. One of the contributing factors to this rise of antibiotic resistance5 is a failure to consistently achieve accurate and timely diagnosis of disease6. In many ways this is understandable. The process of arriving at an accurate diagnosis is complex and once it is achieved then both system and human error can still occur along the way, from the prescription and dosing of medication, through to patient compliance and accurate feedback of the patient’s condition to the physician7. For example:
- Incorrect or incomplete diagnosis, may result in incorrect treatment plan and medical prescription
- Incorrect dosing of medicine, or failure by patient to comply with the prescribed dosing regimen, or in extreme cases where the medication is delivered to the wrong patient
- Time is another critical aspect when it comes to receiving treatments. Delays in treatment can cause significant complications and even death, as per the tragic case of in New York in 20128 where a 12-year-old boy might have been saved if his abnormal lab results had come earlier to the physician’s attention.
What is lab automation?
Discussions on lab automation for scientific research can be found dating back to 18759, but in the more recent past, the first fully automated lab was brought to life by Dr. Masahide Sasaki in early 1980s at the Kochi Medical School Hospital in Japan.
Reducing variation and delivering quality, timely results are virtues that laboratories constantly strive to achieve.
Joe Ross, senior manager for automation and clinical systems at Beckman Coulter Diagnostics10
Dr. Masahide trained medical technologists to assemble conveyor belts and electronic circuit boards, with the aim of reducing errors, containing costs and achieving unprecedented turnaround times through automation and robotic systems.
These first steps were successful in demonstrating the potential for lab automation, and since then demand for this type of system has increased steadily. Technavio, a leading technology market research company, predicts that the lab automation market will grow at an accelerating pace through 2019 in the US, and we believe the growth rates are much higher in the rest of the world where the penetration of lab automation systems is lower.
Drivers of lab automation
Currently there are four main products segments inside the lab automation market. 1) Work station; 2) Information management system; 3) Specimen handling system; 4) Sample transport system. Automation of these four product areas is already possible to a degree through various software and robotic systems, offering reduced cycle times, increased productivity and improved data quality.
Demand for lab automation is greatest in fields such as biotech and pharmaceutical research, academic and scientific research and clinical diagnostics. There are two main drivers behind this demand. On one hand, stricter quality requirements from regulators favor lab automation over human processes, to increase consistency and reduce the risk of error and contamination. On the other hand, as the sheer volume of lab tests increase, driven by an ageing population, hospitals and labs need to increase productivity and efficiency while keeping costs in check.
The solution to these error challenges lies in task-targeted automation that can tirelessly perform routine extra-analytical functions such as sample inspection, sorting, centrifugation, transportation, and post-analytical processing.
Robin Felder, professor of pathology at University of Virginia School of Medicine
Million Insights, a provider of industry market reports, predicts that clinical lab services will grow at an annual growth rate of more than 6.3% from 2014 – 202511 . At the same time, they highlight that clinical labs are vitally important to the healthcare industry, since approximately 80% of physicians’ diagnoses are based on lab analysis.
Automating the steps before and after
Studies from National Center for Biotechnology Information (NCBI) conclude that in diagnostic testing up to 68% of total errors occur in the pre-analysis phase and up to 47% of errors occur in the post-analysis phase12, in other words outside the scope of the lab test itself. The study states that such errors are often due to poor communication pre or post analysis, or incorrect procedure in the pre-analysis stage performed by physicians, nurses, and phlebotomists.
According to Robin Felder, professor of pathology at the University of Virginia School of Medicine, these errors can have profound consequences on patient safety. He concurs that many errors can happen before and after the diagnostic analysis, such as specimen mislabeling, misidentification, missorting, improper routing and pour-off (decanting). Here again, automated solutions may provide a solution in this pre-analysis phase, for example:
- Computerized entry to simplify test ordering and eliminate the need for someone to transcribe the orders.
- Automated tray preparation for phlebotomy13 , to provide a complete set of labeled blood tubes.
- Specimen labelling with high-density (QR) codes that carry far more comprehensive information than simple bar codes, and can be connected to real-time QR locator.
- These QR codes can be connected to a “QR locator” which can provide real-time information on specimen collection and make it possible to track a specimen through transport, processing and storage.
It is surprising to learn that in the post-analytic phase, errors can occur from something as simple as sending the results to the wrong physician and having to resend results later, or failing to call a physician with critical results14. We expect that technology applied to automate the delivery of lab results will play an important role in reducing this type of error, for example by allowing physicians to access a secure portal, which collates all of their patients’ lab results. This system not only delivers results faster, but also saves time for highly skilled lab staff, freeing them up to perform more value-added duties.
We believe that more accurate and more timely diagnostic results driven by ageing demographics and increased regulation, will become critical as volumes escalate and healthcare costs continue to rise. As technology advances, the cost of lab automation will come down, which facilitates the adoption of more of these systems into the labs. At the same time, we believe that technology innovations will result in better automated lab equipment and systems, which will be capable of generating faster and more accurate diagnostics. We expect to see improved cost efficiencies for hospitals and clinics, as well as better patient outcomes.
As long-term oriented investors, we believe that health safety systems, as well as lab automation and more broadly robotics and security, are interesting long term secular growth themes for patient investors. We also believe that we are still in the early innings of these themes. Based on these convictions, we are shareholders of a number of companies with innovative solutions and technologies focused raising the bar in automated lab systems.